Theme: Heart diseases

Discussion in 'Plab 1 and 2 forum' started by Partha Sarkar, Feb 9, 2013.

  1. A Anomalous origin of the left coronary artery from the pulmonary trunk
    B Asymmetric hypertrophy of the ventricular septum with myocyte disarray histologically
    C Concentric thickening of ventricular myocardium. Histologically, translucent refractile material between monocytes which stains with Congo Red
    D Coronary artery stenosis. Histologically the plaque has a thick fibrous cap and a lipid-rich core
    E Coronary artery stenosis. Histologically the plaque has a thin fibrous cap which has ruptured and there is overlying thrombus
    F Dysplastic pulmonary valve leaflets with restricted valve opening
    G Elongation of chordae tendinae and mitral valve leaflets. Histologically, myxomatous degeneration of these tissues
    H Enlarged left ventricular with reduced wall thickness. Histologically cardiac fibrosis, patchy myocyte hypertrophy and low grade chronic inflammatory infiltrate
    I Fibrofatty replacement of the right ventricular myocardium, with aneurysm formation
    J Morphologically and histologically normal heart, but at molecular level, abnormality of ion channel function
    K No gross pathological abnormality, but histologically fibrous replacement of the conducting system
    L Thickened bicuspid aortic valve with restricted opening

    For each of the following case histories, which is the most likely underlying cardiac pathology?

    1. A 23-year-old man complains of recurrent exertional syncope and breathlessness. He has a jerky pulse, a double apical impulse and an ejection systolic murmur at the left sternal edge which is a louder on standing.

    2. A 35-year-old woman complains of frequent awareness of ‘missed beats’. Cardiac auscultation reveals multiple mid systolic ? and a late systolic murmur.

    3. A 16-year-old previously fit boy dies suddenly. His father has a history of recurrent syncope. The father’s ECGs showed PR interval 0.14 secs, QRS duration 0.1 sec and corrected QT interval 0.48 seconds.

    4. A 53-year-old man presents with a one day history of episodes of retrosternal chest tightness which occurred on minimal exertion or when resting and which lasted for up to half an hour.

    5. A 75-year-old lady complains of recurrent syncope. Clinical examination is normal. Ambulatory ECG monitoring reveals sinus pauses of up to four seconds.

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